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  • Print publication year: 2009
  • Online publication date: August 2011

14 - Decontamination



This chapter discusses the decontamination of humans after exposure to a hazardous substance. Much of the current knowledge surrounding decontamination and the management of the contaminated patient is based primarily on anecdotal evidence, personal experience, and common sense. Individuals who are able to walk into a shower and clean themselves receive a more thorough decontamination than non-ambulatory individuals. Historically, mass exposure to chemicals has been due to agents in the form of a vapor or gas. Clothing removal essentially completes the decontamination process. Recognizing that contaminated victims are present is the first critical step for a successful decontamination program. A basic tenet of emergency response is ensuring scene safety; failure to ensure the safety of responders and other nearby persons risks the creation of more victims. To assist with environmental protection, medical and health workers should dispose of contaminant and contaminated items in a fashion consistent with safe practices.
Koenig, KL. Strip and shower: the duck and cover for the 21st century. Ann Emerg Med. 2003;42(3):391–394.
Levitin, H, Siegelson, H. Hazardous materials emergencies. Disaster Medicine. Philadelphia: Lippincott Williams and Wilkins; 2002:258–273.
OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. Occupational Safety and Health Administration, U.S. Department of Labor, OSHA 3249–08N; 2005.
Cox, RD. Decontamination and management of hazardous materials exposure victims in the emergency department. Ann Emerg Med. 1994;23:761–770.
Rothberg, P. Hazardous Materials Transportation: Vulnerability to Terrorists, Federal Activities, and Options to Reduce Risks. Congressional Research Service, The Library of Congress, Oct 15, 2001.
Europe Chemical Industry Council, Position Paper, Competitive and Sustainable Logistics, a European Challenge, May 1998. Available at: Accessed November 14, 2008.
Office of Waste Management, Conservation and Protection, Environment Canada. Transporting Hazardous Waste. Published by authority of the Minister of the Environment, Minister of Supply and Services, Canada; 1991. Cat. No. En 40–204/3–1991, ISBN 0–662–54947–3.
U.S. Department of Health and Human Services, Agency for Toxic Substances and Disease Registry, Hazardous Substance Emergency Event Surveillance, Annual Report 2004, Division of Health Studies, Surveillance and Registries Branch, Atlanta, GA.
Levitin, H, Siegelson, H, Dickinson, S, et al. Decontamination of Mass Casualties – Re-evaluating Existing Dogma. Prehosp Disaster Med. 2003;18:199–207.
Hurst, G Decontamination. In: Textbook of Military Medicine, Warfare, Weaponry, and the Casualty. Medical Aspects of Chemical and Biological Warfare. Washington, DC: Office of the Surgeon General, Department of the Army; 1997:351–359.
Lake, W. Chemical Weapons Improved Response Program. Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident. Domestic Preparedness Program, US Soldier Biological and Chemical Command; 2000.
,Institute of Medicine. National Research Council. Chemical and Biological Terrorism. Research and Development in Improved Civilian Medical Response. Washington, DC: National Academies Press; 1999:97–109.
Gruber, R, Laub, D. The effect of hydrotherapy on the clinical course and pH of experimental cutaneous chemical burns. Plast Reconstr Surg. 1995;55(2):200–204.
Leonard, L, Scheulen, J, Munster, A. Chemical burns: effect of prompt first aid. J Trauma. 1982;22(5):420–423.
Moran, K, O'Reilly, T, Munster, A. Chemical burns. A ten-year experience. Ann Surg. 1987;53(11):652–653.
Fredrikson, T. Percutaneous absorption of parathion and paraxon. Arch Environ Health. 1961;3:67–70.
Brown, V, Box, V, Simpson, BJ. Decontamination procedures for skin exposed to phenolic substances. Arch Environ Health. 1975;30:3–6.
Correri, P, Morris, M, Pruitt, B. The treatment of chemical burns: specialized diagnostic, therapeutic, and prognostic considerations. J Trauma. 1970;30:634–642.
Wexter, R, Malbach, H. In-vivo percutaneous absorption and decontamination of pesticides in humans. J Toxicol Environ Health. 1985;16:25–37.
Weber, L, Zesch, , Rozman, K. Decontamination of human skin exposed to 2,3,7,8-tetrachlorodibenzene-p-diuain (CDD) in vitro. Arch Environ Health. 1992;47(4):302–308.
Nocera, A, Levitin, H, Hilton, M. Dangerous bodies: a case of fatal aluminum phosphide poisoning. Med J Aust. 2000;173(3):133–135.
Schultz, M, Cisek, J, Wabeke, R. Simulated exposure of hospital emergency personnel to solvent vapors and respirable dust during decontamination of chemically exposed patients. Ann Emerg Med. 1995;26(3):324–329.
Lavoie, FW, Coomes, T, Cisek, JE, et al. Emergency department external decontamination for hazardous chemical exposure. Vet Hum Toxicol. 1992;34:61–64.
Siegelson, H. Preparing for terrorism and hazardous materials exposures: It's a matter of worker safety. Health Forum J Am Hosp Assoc. 2000; January.
Auf der Heide, E. The importance of evidence-based disaster planning. Ann Emerg Med. 2006;47(1):34–49.
Koenig, KL, Goans, RE, Hatchett RJ, et al. Medical treatment of radiological casualties: current concepts. Ann Emerg Med. 2005;45(6):643–652.
Macintyre, AG, Christopher, GW, Eitzen, E Jr, et al. Weapons of mass destruction events with contaminated casualties: effective planning for health care facilities. JAMA. 2000;283(2):242–249.
Bartholomew, RE. Mystery illness at Melbourne airport: toxic poisoning or mass hysteria? Med J Aust. 2005;183(11–12):564–566.
Hazardous Waste Operations and Emergency Response. Vol 29 CFR Part 1910.120: U.S. Department of Labor, Occupational Safety and Health Administration.
Canadian Centre for Occupational Health and Safety. Available at: Accessed November 14, 2008.
Brouwer, DH, Marquart, H, Hemmen, JJ. Proposal for an Approach with Default Values for the Protection Offered by PPE, Under European New or Existing Substance Regulations. Ann Occcup Hyg. 2001;45:543–553.
Japan International Center for Occupational Safety and Health, Ordinance on Industrial Safety and Health. Ministry of Labour Ordinance No. 32 & 212, Chapter II.
Centers for Disease Control and Prevention. Emergency Preparedness and Response. Available at: Accessed November 14, 2008.
U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID). Available at: Accessed November 14, 2008.
US Department of Homeland Security. Available at: Accessed November 14, 2008.
Agency for Toxic Substances and Disease Registry. Available at: Accessed November 14, 2008.
U.S. Army Soldier and Biological Chemical Command (SBCCOM). Guidelines for Mass Casualty Decontamination During a Terrorist Chemical Agent Incident. January, 2000.
Environmental Protection Agency Alert Bulletin. First responders' environmental liability due to mass decontamination runoff. EPA 550-F-00–009. Environmental Protection Agency, Office of Solid Waste and Emergency Response; 2000.
Nearly 30 Workers Recovering After Chemical Spill. WLKY News, 2005.
Auf der Heide, E. Disaster planning, Part II. Disaster problems, issues, and challenges identified in the research literature. Emerg Med Clin North Am. 1996;14(2):453–480.
Okumura, T, Suzuki, K, Fukuda, A, et al. The Tokyo subway sarin attack: disaster management, Part 2: Hospital response. Acad Emerg Med. 1998;5(6):618–624.
Okumura, T, Takasu, N, Ishimatsu, S, et al. Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med. 1996;28(2):129–135.
Horton, DK, Berkowitz, Z, Kaye, WE. Secondary contamination of ED personnel from hazardous materials events, 1995–2001. Am J Emerg Med. 2003;21(3):199–204.
Horton, DK, Burgess, P, Rossiter, S, Kaye, WE. Secondary contamination of emergency department personnel from o-chlorobenzylidene malononitrile exposure, 2002. Ann Emerg Med. 2005;45(6):655–658.
Nosocomial poisoning associated with emergency department treatment of organophosphate toxicity – Georgia, 2000. MMWR. 2001;49(51–52):1156–1158.
Koenig, KL, Boatright, CJ, Hancock, JA, et al. Healthcare facility-based decontamination of victims exposed to chemical, biological, and radiological material. Am J Emerg Med. 2008; 26(1):71–80.